Late results of acute medial necrosis in rabbit aorta

Bilateral blindness following Russell's viper bite - a rare clinical presentation: a case report

INTRODUCTION

Russell's viper (Daboia russelii) is one of the most common medically important snakes reported in Sri Lanka. Its envenomation leads to significant mortality and morbidity with local, hematological, neurological and renal complications. Here we report the case of a patient who presented with bilateral blindness secondary to a bilateral posterior circulation ischemic stroke instead of the usual neurological manifestations of Russell's viper envenomation. There were no reported cases of cortical blindness following a Russell's viper bite. Only a few reported cases of ischemic strokes following a Russell's viper bite were found in the literature.

CASE PRESENTATION

A 54-year-old Sri Lankan woman developed bilateral blindness due to a posterior circulation infarct following Russell's viper envenomation.

CONCLUSION

Ischemic stroke following a Russell's viper bite is very rare and cortical blindness is not reported as the clinical presentation. Also, we emphasize the importance of considering the possibility of ischemic stroke in patients who develop unusual neurological manifestations following Russell's viper envenomation.

Multiple thrombotic occlusions of vessels after Russell's viper envenoming

Systemic bleeding due to consumption coagulopathy and thrombocytopenia due to activation of procoagulants is the leading manifestation and cause of death in Russell's viper systemic envenoming. Thrombotic occlusion of the blood vessels is rare in cases of snakebite. In this report, two adult patients with Russell's viper systemic envenoming presented multiple cerebral infarctions, digital gangrenes and ischaemic organs in addition to typical clinical manifestations of bleeding diathesis and renal involvement. Our findings in these two special cases suggest that the venom-induced coagulopathy and endothelium damage, predisposed by toxin-induced vasoconstriction, might be the possible mechanism of multiple thrombotic vascular occlusions in systemic envenoming of Formosan Russell's viper.